1. PYELONEPHRITIS Presented By: Jillymae Medina

2. Etiology Inflammation of the structures of the kidney:  the renal pelvis  renal tubules  interstitial tissue Almost always caused by E.coli

3. Etiology Usually seen in association with:  Pregnancy  diabetes mellitus  Polycystic  hypertensive kidney disease  insult to the urinary tract from catheterization, infection, obstruction or trauma

4. What happens to the kidney? The kidney becomes edematous and inflamed and the blood vessel are congested The urine may be cloudy and contain pus, mucus and blood Small abscesses may form in the kidney

5. Clinical Manifestations Acute pyelonephritis may be unilater or bilateral, causing chills, fever, prostration and flank pain. Studies has shown that chronic pyelonephritis may develop in association with other renal disease unrelated to infection processes Azotemia (the retention in the blood of excessive amounts of nitrogenous compounds) develops if enough nephrons are nonfunctional

6. Signs and Symptoms Subjective Data in acute pyelonephritis:  pt will become acutely ill, w/ malaise and pain in the costovertebral angle (CVA)  CVA tenderness to percussion is a common finding In the chronic phase the pt may show unremarkable symptoms such as nausea and general malaise

7. Costovertebral Angle (CVA)

8. Chronic Pyelonephritis The autopsy specimen consists of a bisected kidney which is markedly shrunken because of chronic inflammation and Scarring. (B) multiple calculi in the proximal ureter (A) Calyceal system

9. Signs and Symptoms Objective data includes assessing the pt for:  Elevated Temperature  Chills  Pus in the urine Systemic signs occur as a result of the chronic disease:  elevated BP  Vomiting  Diarrhea

10. Diagnostic Tests Diagnosis is confirmed by bacteria and pus in the urine and leukocytosis A clean-catch or catheterized urinalysis with culture and sensitivity identifies the pathogen and determines appropriate antimicrobial therapy

11. Diagnostic Tests IVP will Identify the presence of obstruction or degenerative changes caused by the infection process BUN and Creatine levels of the blood and urine may be used to monitor kidney function

12. Medical Management Pt w/ mild signs and symptoms may be treated on an outpatient basis with antibiotics for 14 to 21 days Antibiotics are selected according to results of urinalysis culture and sensitivity and may include broad- spectrum medications

13. Medicines Ampicillin or vancomycin combined with an aminoglycoside (Nebcin, Garamycin) Cipro Septra Bactrim Floxin

14. Medical Management Adequate fluids at least eight 8-oz. glasses per day Urinary analgesics such as Phenazopyridine (Pyridium) is helpful Follow up urine culture is indicated

15. Nursing Intervetion & Patient Teaching Pt is taught to identify the S&S of infection: Elevated temp. Flank pain Chills Fever Nausea Vomiting Urgency Fatigue General malaise Pt should also be taught: Indications Dose Length of course Side effects Importance of follow up care with the physician on a routine basis

16. Prognosis Prognosis is dependent upon early detection and successful treatment Baseline assessment for every pt must include urinary assessment because pyelonephritis may occur as a primary or secondary disoder